MOHS SURGERY

Mohs micrographic surgery—so named after its developer Dr. Frederic E. Mohs—is a complex yet effective procedure to remove basal and squamous cell carcinomas (skin cancers). Although it is a more time consuming procedure, the cure rates are much higher versus other methods for certain skin cancers.

In Mohs surgery, the physician excises thin sections of tissue and then a Mohs technician preserves and fixes the tissues onto slides. After examining the slides microscopically, the physician removes more thin sections of tissue but only from the areas where the tumor is still present and only until the margins are clear. In essence, this traces out the roots of the tumor with minimal tissue removal.

After Dr. Beverly determines that the margins are clear, the wound is closed by either Dr. Beverly or Dr. Ernest Robinson. Dr. Robinson is board certified in facial plastic and reconstructive surgery with expertise in Mohs surgical repair; he will typically close larger wounds that are located on the face to minimize the esthetic impact of the closure. Dr. Beverly and Dr. Robinson have worked together on Mohs cases for nearly 20 years (since 1996).

Dr. Beverly offers Mohs at either our Aliso Viejo (Orange County) office or at the Pacific Hills Surgery Center in Laguna Hills. See FAQ below for more details.

For more information on Mohs, check out the Patient Brochure by the American Society for Mohs Surgery.

FREQUENTLY ASKED QUESTIONS

What is skin cancer?

Skin cancer is the abnormal growth of skin cells, mainly in the upper layer of skin (epidermis). Although skin cancers generally occur in areas of skin exposed to the sun, they can also develop in areas protected from the sun (such as the soles of your feet). People with light skin or who sunburn easy are at greatest risk, but skin cancer can develop in any person, regardless of skin color or race.

Are all skin cancers the same?

No. There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and melanoma; and together they make up nearly all of diagnosed cases of skin cancer. Basal cell carcinoma is by far the most common, making up almost 80% of diagnosed skin cancer cases. It is a slow growing cancer that starts in the deepest layer of the epidermis (basal layer). Most of the remaining cases of skin cancer are squamous cell carcinoma, which is the second most common form. Squamous cell carcinoma is caused by abnormal growth of cells in the squamous cell layer (upper epidermis). It is a fast growing tumor and much more invasive than basal cell carcinoma. The third type, melanoma, represents a small percentage of skin cancers but large percentage of skin cancer deaths. Melanoma begins in the epidermis’s pigment producing cells (melanocytes), but can easily metastasize to other areas in the body. Melanomas are very aggressive and are the most dangerous form of skin cancer. However, if caught early, melanomas are almost always curable. In fact, if melanomas, basal cell carcinomas and squamous cell carcinomas are caught before spreading to other areas, all three forms have a cure rate greater than 98%.

For more information, the American Academy of Dermatology and the American Cancer Society both have excellent reference websites for skin cancer:

Is Mohs surgery recommended for all types of skin cancer?

No. Mohs surgery is not necessary for all skin cancers. It is a specialized procedure that is optimized for cancers meeting certain criteria:

- Skin cancers on the head and neck

- Tumors larger than 1 inch (2.5 cm)

- Aggressive cell types

- Recurrent tumors

Can all dermatologists perform Mohs surgery?

No, most dermatologists are exposed to Mohs surgery during their residency, but Mohs surgeons complete additional advanced training in Mohs surgery and reconstruction. Dr. Beverly is a Fellow of the American Society for Mohs Surgery and has been performing the procedure at our offices since 1993.

Where does Dr. Beverly perform Mohs surgery?

About 2/3 of Mohs procedures are performed in our Orange County office, with the remaining 1/3 of cases at the Pacific Hills Surgery Center (located in Laguna Hills). The location depends on the case itself as well as the patient’s comfort. Mohs surgery can be quite lengthy and so for a particularly anxious patient or one with multiple tumors, a complex or invasive tumor, or a tumor in a delicate area (such as around the eyes), the patient is usually more comfortable under general anesthesia. Procedures using general anesthesia are performed at the Surgery Center as outpatient surgeries.

If you have been scheduled for surgery at Pacific Hills Surgery Center and need to complete pre-admissions registration, please click the "Patient Registration Form" button in the upper right hand corner of the center's website homepage.

Where can I get more information about Mohs surgery?

At your appointment, Dr. Beverly can answer any questions that you have about the Mohs procedure. Additionally, our office can provide you with an informational DVD on Mohs surgery free of charge. If you would like a copy, please use the Contact Us link above and request one using the form.